Kanagawa Prefectural, Japan
Kanagawa Prefectural, Japan

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Suzuki H.,Kanagawa Prefectural Ashigarakami Hospital | Tsunematsu T.,Kanagawa Prefectural Ashigarakami Hospital | Takahashi H.,Kanagawa Prefectural Ashigarakami Hospital | Yasuda S.,Kanagawa Prefectural Ashigarakami Hospital | And 5 more authors.
Journal of Cardiology Cases | Year: 2017

Heparin-induced thrombocytopenia (HIT) is an adverse immune-mediated drug reaction that is associated with thromboembolic complications. We report the case of an 82-year-old man with unstable angina pectoris who suffered from recurrent arterial thromboembolism due to HIT. Coronary angiography (CAG) was performed while we administered unfractionated heparin bolus. CAG showed triple-vessel disease without left main coronary artery. We performed elective percutaneous coronary angioplasty (PCI) to the left anterior descending coronary artery (LAD). The sudden thrombus formation in the LAD occurred during the procedure. We suspected HIT and administered argatroban. We deployed four everolimus-eluting stents in the LAD and intra-aortic balloon pumping (IABP) support was started. The platelet counts were rapidly reduced almost 50% next day after PCI and IgG-specific anti-PF4/heparin antibodies were elevated. Multiple cerebral infarctions were detected by magnetic resonance imaging after the PCI. The patient received the continuous argatroban administration and IABP support for 4 days. Subacute stent thrombosis occurred after quitting argatroban. We performed thrombus aspiration and fibrinolytic treatment. Finally we re-inserted IABP and stabilized the hemodynamic state. Right popliteal arterial thromboembolism occurred after emergency PCI. Argatroban is essential and following oral anticoagulant therapy is necessary to prevent thromboembolic complications.<. Learning objective: Heparin-induced thrombocytopenia (HIT) is an adverse immune-mediated drug reaction that is associated with thromboembolic complications. The incidence of HIT in patients who received unfractionated heparin is reported to be 0.1- 1%. We should be aware of HIT when thromboembolic complications occur during the percutaneous coronary intervention procedure. Argatroban is essential and following oral anticoagulant therapy is necessary to prevent thromboembolic complications among patients with HIT.>. © 2017 Japanese College of Cardiology.


Kunishi Y.,Kanagawa Prefectural Ashigarakami Hospital | Iwata Y.,Kanagawa Prefectural Ashigarakami Hospital | Ota M.,Kanagawa Prefectural Ashigarakami Hospital | Kurakami Y.,Kanagawa Prefectural Ashigarakami Hospital | And 5 more authors.
Internal Medicine | Year: 2016

A 52-year-old woman presented with recurrent, severe abdominal pain. Laboratory tests and imaging were insignificant, and treatment for functional dyspepsia was ineffective. The poorly localized, dull, and severe abdominal pain, associated with anorexia, nausea, and vomiting, was consistent with abdominal migraine. The symptoms were relieved by loxoprofen and lomerizine, which are used in the treatment of migraine. We herein report a case of abdominal migraine in a middle-aged woman. Abdominal migraine should be considered as a cause of abdominal pain as it might easily be relieved by appropriate treatment. © 2016 The Japanese Society of Internal Medicine.


Iwata Y.,Kanagawa Prefectural Ashigarakami Hospital | Kunishi Y.,Kanagawa Prefectural Ashigarakami Hospital | Yoshie K.,Kanagawa Prefectural Ashigarakami Hospital
Internal Medicine | Year: 2015

We herein report a case regarding a 90-year-old woman with a history of recurrent episodes of urinary tract infections presenting with fever. Urinalysis revealed bacteria and white blood cells. Computed tomography showed dilated and fecally loaded rectum and colon with signs of obstructive uropathy. The patient was treated for urinary tract infection and constipation. Her bowel habits were controlled with lubiprostone, and she was discharged in good medical condition. This case highlights the importance of considering fecal impaction as a cause of urinary tract obstruction or infection. © 2015 The Japanese Society of Internal Medicine.


Takeda R.,Kobe University | Naka A.,Kobe University | Ogane N.,Kanagawa Prefectural Ashigarakami Hospital | Kameda Y.,Kanagawa Prefectural Ashigarakami Hospital | And 4 more authors.
Breast Cancer: Basic and Clinical Research | Year: 2015

Adding platinum drugs to anthracycline/taxane (ANC-Tax)-based neoadjuvant chemotherapy (NAC) improves pathological com-plete response (pCR) rates in triple-negative breast cancer (TNBC). Copper transporter 1 (CTR1) and organic cation transporter 2 (OCT2) critically affect the uptake and cytotoxicity of platinum drugs. We immunohistochemically determined CTR1 and OCT2 levels in pre-chemotherapy biopsies from 105 patients with HER2-negative breast cancer treated with ANC-Tax-based NAC. In the TNBC group, Ki-67high[pathological good response (pGR), P = 0.04] was associated with response, whereas CTR1high(non-pGR, P = 0.03), OCT2high(non-pGR, P = 0.01; non-pCR, P = 0.03), and combined CTR1high and/or OCT2high(non-pGR, P = 0.005; non-pCR, P = 0.003) were associated with non-response. In multivariate analysis, Ki- 67highwas an independent factor for pGR and CTR1 for non-pGR. Combined CTR1/OCT2 was a strong independent factor for non-pGR. How-ever, no variables were associated with response in luminal BC. These results indicate that platinum uptake transporters are predominantly expressed in ANC-Tax-resistant TNBCs, which implies that advantage associated with adding platinum drugs may depend on high drug uptake. © the authors, publisher and licensee Libertas Academica Limited.


PubMed | Kanagawa Prefectural Ashigarakami Hospital, Kobe University and Kanagawa Cancer Center Hospital
Type: | Journal: Breast cancer : basic and clinical research | Year: 2015

Adding platinum drugs to anthracycline/taxane (ANC-Tax)-based neoadjuvant chemotherapy (NAC) improves pathological complete response (pCR) rates in triple-negative breast cancer (TNBC). Copper transporter 1 (CTR1) and organic cation transporter 2 (OCT2) critically affect the uptake and cytotoxicity of platinum drugs. We immunohistochemically determined CTR1 and OCT2 levels in pre-chemotherapy biopsies from 105 patients with HER2-negative breast cancer treated with ANC-Tax-based NAC. In the TNBC group, Ki-67(high) [pathological good response (pGR), P = 0.04] was associated with response, whereas CTR1(high) (non-pGR, P = 0.03), OCT2(high) (non-pGR, P = 0.01; non-pCR, P = 0.03), and combined CTR1(high) and/or OCT2(high) (non-pGR, P = 0.005; non-pCR, P = 0.003) were associated with non-response. In multivariate analysis, Ki-67(high) was an independent factor for pGR and CTR1 for non-pGR. Combined CTR1/OCT2 was a strong independent factor for non-pGR. However, no variables were associated with response in luminal BC. These results indicate that platinum uptake transporters are predominantly expressed in ANC-Tax-resistant TNBCs, which implies that advantage associated with adding platinum drugs may depend on high drug uptake.


PubMed | Kanagawa Prefectural Ashigarakami Hospital
Type: Journal Article | Journal: Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology | Year: 2016

An 83-year-old male presented with distended abdomen. A computed tomography scan demonstrated pleural effusion, ascites, peritoneal thickness, and panniculitis. Multiple small white nodules of peritoneum were observed during a laparoscopy examination, and biopsy specimens revealed noncaseating granulomas. Gallium scintigram demonstrated an accumulation in the peritoneum and revealed a panda sign that has been described as an indication of sarcoidosis. Although sarcoidosis rarely induces peritonitis with ascites, peritoneal sarcoidosis was diagnosed and he began receiving steroid therapy. After primary steroid therapy, his ascites completely disappeared, and he has maintained a complete response with continuous low dose steroid therapy.


PubMed | Kanagawa Prefectural Ashigarakami Hospital, Higashiyamato Hospital and Kobe University
Type: Journal Article | Journal: Histopathology | Year: 2016

Alpha-fetoprotein (AFP)-producing gastric cancer (GC) is an aggressive tumour with high rates of liver metastasis and poor prognosis, and for which a validated chemotherapy regimen has not been established. Drug uptake by solute carrier (SLC) transporters is proposed as one of the mechanisms involved in sensitivity to chemotherapy. In this study, we aimed to develop important insights into effective chemotherapeutic regimens for AFP-producing GC.We evaluated immunohistochemically the expression levels of a panel of SLC transporters in 20 AFP-producing GCs and 130 conventional GCs. SLC transporters examined were human equilibrative nucleoside transporter 1 (hENT1), organic anion transporter 2 (OAT2), organic cation transporter (OCT) 2, OCT6 and organic anion-transporting polypeptide 1B3 (OATP1B3). The rates of high expression levels of hENT1 (hENT1Because hENT1 and OAT2 are crucial for the uptake of gemcitabine and 5-fluorouracil, respectively, our results suggest that patients with AFP-producing GC could potentially benefit from gemcitabine/fluoropyrimidine combination chemotherapy. Increased expression of hENT1, OAT2 and OCT6 may also be associated with the progression of GC.


PubMed | Kanagawa Prefectural Ashigarakami Hospital
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2017

A 63-year-old man underwent low anterior resection for rectal cancer.A synchronous liver metastasis located in segment 8 was 12 cm in diameter and unresectable due to its proximity to the inferior vena cava(IVC).The postoperative pathological findings revealed a T3(SS), N0, M1(liver)Stage IV tumor, and wild type K-RAS was expressed.We chose FOLFIRI plus cetuximab(Cmab)for first-line chemotherapy.After 6 courses, we changed the molecular target drug from Cmab to bevacizumab( Bmab)because the liver metastasis remained unresectable.The patient had long-term stable disease(SD)for approximately 30 months with the FOLFIRI-based regimen.We then changed the regimen to mFOLFOX6 plus Bmab for second-line, Cmab for third-line, and trifluridine/tipiracil hydrochloride for fourth-line chemotherapy to treat progressive disease(PD).After treatment with these chemotherapies, the patient wished to continue treatment.We restarted FOLFIRI plus Bmab for fifth-line chemotherapy as his general condition was still good.Consequently, his tumor markers levels decreased with stabilization of the disease on CT scans, and he continued therapy for 6 months while maintaining a good quality of life.This case suggested that rechallenge with anti-cancer agents could be effective and improve the prognosis of colorectal cancer patients after using all key drugs.


PubMed | Kanagawa Prefectural Ashigarakami Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2015

We report a case of an intractable fistula repaired by transsacral direct suture. A 65-year-old man underwent low anterior resection for rectal cancer. He subsequently underwent ileostomy due to anastomosis leakage. The fistula of the anastomosis persisted 3 months after surgery. He underwent surgery to repair the fistula using a transsacral approach. After removing the coccyx, the fistula in the postrectal space was exposed directly. The presence of the fistula was confirmed by an air leak test and was closed by direct suture. After 33 days, the patient underwent ileostomy closure.


PubMed | Kanagawa Prefectural Ashigarakami Hospital
Type: Journal Article | Journal: Internal medicine (Tokyo, Japan) | Year: 2016

A 52-year-old woman presented with recurrent, severe abdominal pain. Laboratory tests and imaging were insignificant, and treatment for functional dyspepsia was ineffective. The poorly localized, dull, and severe abdominal pain, associated with anorexia, nausea, and vomiting, was consistent with abdominal migraine. The symptoms were relieved by loxoprofen and lomerizine, which are used in the treatment of migraine. We herein report a case of abdominal migraine in a middle-aged woman. Abdominal migraine should be considered as a cause of abdominal pain as it might easily be relieved by appropriate treatment.

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